In this episode, I’ll discuss whether subcutaneous VTE prophylaxis should be given during therapeutic hypothermia.
Shout out to Hospital Pharmacy Academy member, “Pharmacy Yor” for inspiring this episode.
During therapeutic hypothermia, subcutaneous drug absorption may be reduced due to low perfusion to the skin. This may be especially true if the injection site is near the application site of surface cooling methods.
When reviewing the protocols and supplementary appendices of prominent articles published on therapeutic hypothermia, I was unable to find any mention of VTE prophylaxis use.
Even the Neurocritical Care Guidelines on therapeutic hypothermia do not directly address whether these patients should have subcutaneous chemoprophylaxis for VTE.
Patients undergoing therapeutic hypothermia are probably at risk for VTE like any other critically ill patient cohort, and some single center retrospective studies suggest there is an elevated risk of VTE in these patients.
Two organizations that publish their institutional therapeutic hypothermia protocol online do suggest subq VTE chemoprophylaxis: Univeristy of Pennsylvania and Orlando Regional Medical Center.
While it is true that “other centers use it” is not an evidence-based approach, there also appears to be insufficient evidence to recommend avoiding subcutaneous VTE chemoprophylaxis. Therefore this decision will likely be handled on a local level until further evidence is published.
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